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          Abstract

          Objectives

          The primary objective of this study was to compare the 12-month continuation rate for women who self-injected subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) with that for women receiving intramuscular depot-medroxyprogesterone acetate (DMPA-IM) from a provider. This research contributes to the broader goal of identifying solutions to support women to use contraception for their full desired duration.

          Study design

          Participants were clients from 13 clinics in the Dakar and Thiés regions of Senegal who had decided to use injectable contraception prior to enrollment. They chose self-injection of DMPA-SC or provider administration of DMPA-IM. Self-injectors were trained and given three units of DMPA-SC. The provider-injected group received DMPA-IM and returned to the clinics for future injections. We interviewed participants at baseline and after the second, third and fourth injections (the equivalent of 12 months of contraceptive coverage). We employed Kaplan–Meier methods to estimate continuation probabilities, with a log-rank test to compare differences between groups. A multivariate Cox regression identified factors correlated with discontinuation.

          Results

          The 12-month continuation rate for 650 women self-injecting DMPA-SC was 80.2%, while that for 649 women receiving DMPA-IM from a provider was 70.4% (p<.01). The difference in continuation between self-injectors and those receiving DMPA from a provider remained significant in a multivariate Cox regression model. The primary reason for discontinuation in both groups (44.7% self-injected; 44.5% provider-injected) was forgetting to reinject or reinjecting late. Fewer women reported side effects in the self-injection group than in the provider-administered group.

          Conclusions

          The higher 12-month continuation rate for women self-injecting DMPA-SC relative to provider-administered DMPA-IM suggests that self-injection may help prevent pregnancy more consistently and continuously.

          Implications

          Discontinuation of injectable contraception among women wishing to avoid pregnancy may increase unmet need in francophone West Africa. This study showed higher 12-month continuation rates for women who self-injected DMPA-SC, suggesting that this delivery method may improve injectable continuation.

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          Mobile phone-based interventions for improving contraception use.

          Chris K Smith, Judy Gold, Thoai Ngo … (2015)
          Contraception provides significant benefits for women's and children's health, yet an estimated 225 million women had an unmet need for modern contraceptive methods in 2014. Interventions delivered by mobile phone have been demonstrated to be effective in other health areas, but their effects on use of contraception have not been established.
          Article 0 comments Cited 49 times – based on 0 reviews     Review now
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            Effect of self-administration versus provider-administered injection of subcutaneous depot medroxyprogesterone acetate on continuation rates in Malawi: a randomised controlled trial

            Silver Wevill, Bagrey Ngwira, Mario Chen … (2018)
            Injectable contraceptives are popular in sub-Saharan Africa but have high discontinuation rates due partly to the need for provider-administered re-injection. We compared continuation rates of women who self-injected subcutaneous depot medroxyprogesterone acetate (DMPA-SC) and women who received DMPA-SC from a health-care provider, including community health workers (CHWs).
            Article 0 comments Cited 39 times – based on 0 reviews     Review now
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              Strategies to improve adherence and acceptability of hormonal methods of contraception.

              Vera Halpern, Laurie Stockton, Maria F. Gallo … (2013)
              Worldwide, hormonal contraceptives are among the most popular reversible contraceptives. Despite their high theoretical effectiveness, typical use results in much lower effectiveness. In large part, this disparity reflects difficulties in adherence to the contraceptive regimen and low rates for long-term continuation.
              Article 0 comments Cited 28 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jane Cover
                Journal
                Journal ID (nlm-ta): Contraception
                Journal ID (iso-abbrev): Contraception
                Title: Contraception
                Publisher: Elsevier
                ISSN (Print): 0010-7824
                ISSN (Electronic): 1879-0518
                Publication date PMC-release: 1 February 2019
                Publication date (Print): February 2019
                Volume: 99
                Issue: 2
                Pages: 137-141
                Affiliations
                [a ]PATH, PO Box 900922, Seattle, WA 98109, USA
                [b ]PATH, BP 15115, Dakar-Fann, Dakar, Senegal
                [c ]Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
                Author notes
                [* ]Corresponding author. Tel.: +1 206 302 4708. jcover@ 123456path.org
                Article
                Publisher ID: S0010-7824(18)30482-7
                DOI: 10.1016/j.contraception.2018.11.001
                PMC ID: 6367564
                PubMed ID: 30439358
                SO-VID: 5064193c-c66c-4228-a865-765f37759ef0
                Copyright © © 2018 The Author(s)
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 23 August 2018
                Date revision received : 2 November 2018
                Date accepted : 5 November 2018
                Categories
                Subject: Article

                Keywords: self-injection,self-administration,injectable contraception,depot-medroxyprogesterone acetate,subcutaneous dmpa,dmpa-sc
                Data availability:
                Keywords: self-injection, self-administration, injectable contraception, depot-medroxyprogesterone acetate, subcutaneous dmpa, dmpa-sc

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